My Doctor Online The Permanente Medical Group
Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Overview
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Acne is the most common skin problem in the United States, affecting millions of adolescents and adults. About 85 percent of teens have acne, and it may continue into adulthood.
Acne is a complex condition in which hormones and other factors can cause the hair follicles in your skin to become clogged. This can create pimples or pus bumps that become visible on your face, neck, back, chest, and shoulders. Acne can be distressing, but there are effective combinations of treatments available that can help you.
Additional References:
- External Link to Acne: Should I see my doctor?
- Acne Medications and Treatments
Symptoms
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The symptoms of acne can be mild to severe, and they include:
- Pimples, pus bumps, whiteheads, blackheads, and cysts
- Discoloration of the skin
- Pain
- Swelling
- Scarring
Severe acne can also lead to other problems. It may affect your emotional well-being, causing depression, embarrassment, or lowered self-esteem. These negative feelings can discourage you from interacting socially, on the job, or at school.
Diagnosis
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We can usually diagnose acne by looking at your skin. In most cases, no additional testing is needed.
In rare cases, there are problems with hormone levels that may be linked to a condition called polycystic ovary syndrome, or PCOS. If you are a woman with moderate to severe acne, irregular menstrual periods, and excess hair on the face or body, you may have PCOS or another hormonal imbalance.
Types
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There are several different types of acne lesions. Most of the time, if you have acne, you will have a combination of these lesions in varying severity:
- Blackheads and whiteheads (also called comedonal lesions). These are spots or bumps on your skin, caused when the opening of a hair follicle gets plugged. Because these lesions can progress, it is important to treat them at an early stage.
- Pimples (also called inflammatory lesions). This type is the classic lesion better known as a pimple or pus bump. When hair follicles get clogged with oil (also known as sebum), the clogged pores become swollen or inflamed, resulting in pimples or pus bumps on the skin.
- Cysts (known as nodulocystic lesions). These develop when smaller inflamed lesions swell up into larger lesions. These are deep painful lesions that can last from a few days to several weeks and often lead to scarring and discoloration.
- Scars are the last stage of acne resulting from severe inflammatory lesions. They are usually permanent.
Causes
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The following factors cause acne:
- Increased stickiness of the cells in the hair follicles, combined with sebum (oil), creating a plug in the hair follicle
- Increased production of sebum, or oil, especially during adolescence, when hormones increase
- Increased growth and activity of bacteria called Propionibacterium acnes, also known as P. acnes
As you go through puberty, some hormones cause your skin to produce more oil. This oil combines with a buildup of debris and shedding skin, causing hair follicles on your face and other acne-prone areas to plug up. This causes the acne lesions.
More sebum results in an increase in the number of bacteria (P. acnes) on the skin surface. As bacteria break down surface oil and interact with your immune system, your skin becomes irritated and inflamed. This causes acne pimples to form.
Because the highest concentration of the sebaceous or oil glands is present on the face, chest, and back, these are the areas where acne usually develops.
Hormonal changes
Hormones are one of the most important causes of acne. Several kinds of hormonal changes can affect this condition, including:
- Puberty brings a surge in sex hormones, resulting in an increase in sebum production by the sebaceous glands in our skin.
- Menstrual periods can cause acne to flare up because of hormone level changes during the menstrual cycle.
- Polycystic ovary syndrome (PCOS) is characterized by severe acne, excess hair growth, premature loss of hair on the scalp, and irregular menstrual periods.
Diet
The role of diet in acne remains controversial. It is best to avoid foods that make your acne worse. Some studies suggest that milk and other dairy products may increase the risk or severity of acne because of the animal hormones they contain.
Foods rich in carbohydrates, such as simple sugars found in candy, cookies, and other baked goods, may make acne worse. There is no good evidence that chocolate or fried foods cause or worsen acne.
Stress
Stress and tension have been shown to worsen acne. When we are stressed, our body releases cortisol – a natural steroid hormone that further increases your skin's production of oil.
Medications
Certain medications are known to worsen acne. These include medications that contain steroids such as prednisone, methyl prednisolone, topical steroids, and some psychiatric medications such as lithium.
Other factors
- Oil-based cosmetics may worsen acne by clogging your pores. We recommend that you try water-based "non-comedogenic" cosmetic products if you have acne.
- Overwashing the skin. Using rough washcloths or aggressively scrubbing your skin to try and remove dirt may make your acne worse by causing irritation and inflammation. Dirt is not the cause of acne.
- Heat and friction. Helmets, bra straps, shoulder pads, adhesive tape, orthopedic casts, and other constricting items that rub against the skin may worsen acne.
Your Care with Me
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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.
If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might contact me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we may discuss your medical and family history and I will examine your skin. Usually, no special tests are needed. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.
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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
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Coordinating Your Care
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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
If you come to an office visit
- At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need.
- At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
- To help you prepare for your visit, please see additional details under Office Visit.
If I prescribe medications
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:- Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
- Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If I refer you to another specialty colleague
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
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Convenient Resources for You
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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
Manage your care securely
- View and compose secure e-mail messages.
- Manage your prescriptions.
- View your past visits and test results.
- View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
- Read about causes, symptoms, treatments and procedures.
- Find interactive health tools, videos, and podcasts to help you manage your condition.
- View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
- Locate health education classes and support groups offered at every medical center.
- Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
- View your Preventive Services to see whether you are due for a routine screening or updated immunization.
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Related Health Tools:
Interactive Programs
- Reduce stress with Relax™ Reduce stress with Relax™
- Young Adult Health Website Young Adult Health Website
Podcasts
- Stress Management Stress Management
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.